Dynamic Balance Tests Research Articles

A systematic review and meta-analysis comparing the effect of aquatic and land exercise on dynamic balance in older adults

BackgroundBalance impairments are the leading causes of falls in older adults. Aquatic-based exercises have been broadly practiced as an alternative to land-based exercises; however, the effects on dynamic balance have not been comprehensively reviewed and compared to land exercises. Thus, the purpose of this systematic review and meta-analysis was to compare the effectiveness of aquatic exercises (AE) to land exercises (LE) on dynamic balance in older adults.MethodsElectronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, psycINFO), from inception to November 2019, were searched. Studies met the following eligibility criteria: Randomized controlled trials, English language, older adults aged 65 years or older, a minimum of one AE and LE group, at least one assessment for dynamic balance. For the meta-analysis, the effect sizes of dynamic balance outcomes were calculated using a standardized mean difference (SMD) and a 95% confidence interval (CI).ResultsA total of 11 trials met the inclusion criteria, and 10 studies were eligible for the meta-analysis. The meta-analysis presented that older adults in AE groups demonstrated comparable enhancements in dynamic steady-state balance (SMD = − 0.24; 95% CI, −.81 to .34), proactive balance (SMD = − 0.21; 95% CI, −.59 to .17), and balance test batteries (SMD = − 0.24; 95% CI, −.50 to .03) compared with those in LE groups.ConclusionsAE and LE have comparable impacts on dynamic balance in older adults aged 65 years or older. Thus, this review provides evidence that AE can be utilized as a reasonable alternative to LE to improve dynamic balance and possibly reduce the risk of falls.

Complex Gait in Preschool Children in a Dual‐Task Paradigm Is Related to Sex and Cognitive Functioning: A Cross‐Sectional Study Providing an Innovative Test and Reference Values

ABSTRACTThe purpose of this study was to design and validate a complex gait test (CGT) in preschool children and to examine the relationship between CGT performance and age, sex, and cognitive functioning. A total of 1,040 preschool children, aged 3 to 6 years, participated in this study. In all children, standardized dynamic balance test, and several cognitive functioning measures were used. The results indicate that the CGT has adequate reliability and validity. In the test–retest analysis (n = 90), the intraclass correlation coefficient was 0.901 (p < .001). A significant correlation between the initial test and retest (r = 0.821, p < .001) and between the CGT and dynamic balance test (r = −0.432, p < .001), Porteus Maze Test (PMT) (r = −0.416, p = .011), and Goodenough‐Harris Drawing Test (GHDT) (r = −0.386, p < .001) was found. Boys showed a better performance than girls at 3–6 years old. The CGT showed excellent reliability and validity in preschool children and may serve as a potential biomarker in cognitive development.

EFFECT OF COMPRESSION SOCKS ON POSTURAL BALANCE AMONG UNIVERSITY NETBALL PLAYERS

The purpose of this study was to observe the effects of wearing compression socks on postural balance in university netball players. Fourteen advanced learners' netball players performed three trials (20 seconds for each trial) of dynamic postural balance test on Biodex Stability System, in two socks conditions, (a) Normal Socks and (b) Compression Socks. Data on overall, anterior/posterior and medial/lateral stability indexes were analyzed using Paired Sample T-tests. Results revealed that wearing compression materials significantly enhanced static and dynamic postural balance among the university netball players. The improvement in the key variables is likely to have occurred through enhanced somatosensory feedback information that was received the lower limbs to regulate better postural stability. It is suggested that compression socks can be used by netball players to improve their postural stability possibly during shooting performance.

The Immediate Effects Of Abdominal And Core Exercise On Balance For College-age Dancers

Balance is defined as the ability to maintain a stable position while remaining steady. Balance is extremely important to dancers to help prevent injury and to maximize aesthetic and athletic performance. While other studies support the improvement of balance among dancers following a core exercise training program, the effects immediately following one core exercise session are less clear. PURPOSE: The purpose of this study was to examine the immediate effects of a core and abdominal exercise program on balance for dancers, with the hypothesis that a core exercise program would cause an immediate improvement in balance for college-aged dancers. METHODS: Eighteen female collegiate dancers (19.83 ± 1.58 years, 7-18 years of dance experience) completed two sets of eight exercises, engaging the upper and lower abdominal, obliques, gluteals, and erector spinae muscles. Two static balance tests, the Balance Error Scoring System (BESS) test and the Stork Balance Standing test, and two dynamic balance tests, the Y Balance test and the Pirouette test, were conducted prior to and after the core exercises. RESULTS: The core exercise program significantly improved balance results for the Y Balance Test composite score (86.0 ± 6.3% pre vs 88.4 ± 5.3% post, p<0.05) and the BESS Test (22.7 ± 8.0 errors pre vs 16.1 ± 7.0 errors post, p<0.05). There were no significant differences between pre and post intervention scores of the Stork Balance Standing test or the Pirouette test. CONCLUSIONS: Including core exercises in a dancer’s warm-up before practices and performances may have an acute positive effect on balance for dancers, which could translate to improvements in performance. It is unclear if a core exercise program can acutely improve dance skill-specific balance, such as during pirouettes.

The Relationship Between Perception Of Ankle Instability And Dynamic Balance In Individuals With A History Of Ankle Sprains

PURPOSE: Ankle sprains are common injuries which can progress to chronic ankle instability (CAI) and balance impairments. While objective data guide treatment for individuals with CAI, the patient’s subjective experience is often overlooked and not counted in the adoption of plan of care. Individual perception of ankle instability is an important factor and has the potential to influence presentation of sensorimotor impairments either through neuromotor or fear-avoidance mechanisms. The purpose of this study was to explore the contribution of perception of unilateral and bilateral CAI on a dynamic balance test. METHODS: Subjects were males and females 18-35 years old (n=25, age= 23.8 ± 1.8 yr.). All subjects completed the Cumberland Ankle Instability Tool (CAIT) to measure perceived ankle instability (lower CAIT scores are associated with greater perceived instability). Dynamic balance was assessed using 3 repetitions in each direction (anterior, postero-medial, and postero-lateral) of the Y-Balance Test (YBT). Asymmetries in CAIT scores and reach distances were calculated by subtracting right leg values from left leg values. Further comparisons were analyzed between groups of bilaterally highest (>80%) and lowest (<20%) combined CAIT scores. RESULTS: There was a significant positive moderate correlation between CAIT asymmetries and asymmetries in the anterior reach (r=0.526, p=0.007) and the posteromedial reach scores (r= 0.554, p=0.004). Significant differences were found between participants with the highest (n=5) and lowest (n=5) bilateral CAIT scores in right posteromedial reach (101.60 ± 9.91 vs 86.80 ± 5.89, p=0.02), right posterolateral reach (96.40 ± 7.70 vs 76.80 ± 4.87, p=0.001), and right composite score (89.96 ± 5.93 vs 78.44 ± 3.85, p=0.007). CONCLUSION: Subjects reporting increased perceived ankle instability demonstrated decreased YBT performance on the side of perceived instability. Decreased reach distances may be attributable to neuromuscular consequences of ankle injury, changes in movement strategy associated with apprehension, or both. In fact, the larger the perceived asymmetries the greater the performance deficits. These findings may help clinicians contextualize sensorimotor assessment results in patients with a history of ankle sprain.

Effect of foot anthropometric measurements on postural stability

Aim: To examine the effect of foot anthropometric measurements and body sizes of young male adults with normal posture on balance. Methods: In this study, the effect of body size and foot anthropometric measurements of 112 young male adults with normal posture on balance was investigated. The foot and body parameters of the cases were measured. The static and the dynamic balance tests were evaluated according to the dominant foot in each case. The parameters that affected balance were determined and the variables were taken to the model. In addition, the significance levels that defined the effects of the properties examined in relation with the balance were also calculated. Results: When the findings were evaluated, it was determined that the effect of the foot parameters other than the foot length, and the effect of 15 body parameters other than the biiliac diameter, trochanteric height, and right upper extremity length on balance performance was significant. The balance test performance was predicted with success ranging from 7.8% to 43% with the parameters included in the model. Conclusion: In this study, the fact that the relation between the foot anthropometric and body dimensions and functional balance performances of young male adults was found to be significant shows that this relation must be considered in the creation of a normative database on balance, and in clinical studies that will be conducted on the subject.

Effects Of A Multi-ingredient Dietary Supplement And Tai Chi On Physical Function In Adults

PURPOSE: To examine the effects of a 12-week multi-ingredient dietary supplementation (MIDS) or Tai Chi training on physical function compared to a placebo in middle-aged and older adults. METHODS: In a randomized, double-blind, placebo-controlled design, seventy-five men and postmenopausal women aged 45-75 years were randomly assigned to one of three experimental groups: 1) MIDS (n= 30), 2) placebo tablet (PL, n= 30), or 3) Tai Chi training (EX, n= 15). The supplementation groups took one tablet daily (MIDS or PL), while the EX group performed a 24-form Yang Tai Chi exercise program (1hr/session, 3x/week) for 12 weeks. Physical function was assessed using Tandem Romberg test, single leg stance (SLS) test, dynamic balance test via Biodex Balance System (BBS), timed up and go test (TUG), and functional reach test (FRT) pre- and post-intervention. Data were analyzed with a 3×2 mixed ANOVA and Bonferroni pair-wise comparisons. Significance was accepted p≤.05. RESULTS: In TUG test, there was a significant group x time interaction, as the EX group improved significantly more than the PL group (EX: 8.07±1.18 to 7.08±0.80 s vs. PL: 8.19 ± 1.32 to 8.16 ± 1.36 s). There were significant main time effects in both BBS dynamic test level 2 anterior/posterior scores (EX: 7.94±4.78 to 3.31±1.51 AU, +58.43%), and TUG test (EX: 8.07±1.18 to 7.08±0.80 s, -14%). In addition, the EX group showed significant improvements in SLS from pre- to post-intervention (7.57±7.31 to 13.31±14.25 s, +43.13%). Both the MIDS and EX groups had a significant main time effect in physical health scores in the SF-36 survey (MIDS: 81.6±13.0 to 85.7±10.7, +5%, EX: 79.0±18.6 to 86.1±13.3, +9%) after the interventions. The PL group remained unchanged in aforementioned physical function tests. CONCLUSIONS: In middle-aged and older adults, 12 weeks of Tai Chi exercise improved both static and dynamic balance ability, which is essential in reducing the risk of falls. Tai Chi exercise also significantly improved TUG scores, which indicates advantageous effects on gait and strength. Both the MIDS and Tai Chi interventions improved self-perception of health status, suggesting beneficial effects on the quality of life. Overall, both MIDS and Tai Chi can be beneficial to physical function and quality of life in older adults. Supported by Shaklee Corporation Research Grant.

Recovery Following ACL Reconstruction in Male vs. Female Adolescents: A Matched, Sex-Based Cohort Analysis of 543 Patients

Objectives:The subject of sex-based differences in postoperative recovery after anterior cruciate ligament reconstruction (ACLR) between males and females has been incompletely investigated, with no published comparative analyses specifically in adolescents, which represents the sub-population most affected by ACL injury. The purpose of this study was to compare the 6-month postoperative functional recovery following ACLR between adolescent males and females. We hypothesized that significant differences in postoperative strength, dynamic balance, and functional hop test performance would be seen between the sexes.Methods:All adolescent athletes with closed or closing growth plates who underwent ACLR at a single institution between May 2014 and May 2018 and who underwent functional return-to-sport (RTS) testing between 5-8 months post-operatively were considered for inclusion in this IRB-approved study. To control for potential graft-based rehabilitation differences or donor site morbidity as confounders, only primary ACLRs performed with hamstring autograft were included. Exclusion criteria were previous knee surgery (contralateral or ipsilateral knee), concomitant injury/surgery other than meniscus tear/repair, allograft supplementation, and incomplete medical records. Limb Symmetry Indexes (LSI) for strength (quadriceps, hamstrings, hip abductors, hip extensors), dynamic Y-balance (anterior, posterolateral and posteromedial distance), and functional hop test performance (single hop, triple hop, cross-over hop for distance, and 6-meter timed hop) were compared between groups. To account for differences in physical characteristics between the sexes, one-way between group multivariate analysis of covariance (MANCOVA) was used, with p = 0.05.Results:Amongst 543 subjects (211 male, 332 female), there was no significant difference in age, BMI, incidence of concomitant meniscal pathology, use of regional anesthesia blocks, or time to functional testing between cohorts. However, the height and weight differences, which were expected, were incorporated in the MANCOVA model. Females demonstrated a statistically significantly greater deficit in quadriceps strength LSI compared to males (Table 1). Both males and females demonstrated 33% hamstring strength deficits, with no statistically significant sex-based differences in dynamic balance or functional hop testing, though single leg hop deficits were less severe in males, which trended towards significance (-4% vs. -8%, p=0.062).Conclusion:Females demonstrated greater quadriceps strength deficits than males at 6 months post-ACLR with hamstring autograft, which may translate into greater functional hop testing deficits. Severe hamstring strength deficits persist in both males and females at this time point, underscoring the potential importance of mitigating risk of ACL re-tear by delaying return to play until a later time point with more normalized, symmetric, performance-based metrics.

Verbal Encouragement Improves Star Excursion Balance Test Performance In Patients With Chronic Ankle Instability

PURPOSE:The Star Excursion Balance Test (SEBT) is a common dynamic balance test. Functional limitations on the SEBT are associated with CAI, but psychological constraints such as kinesiophobia or a lack of confidence may affect performance. The purpose of this study was to investigate the effects of verbal encouragement (VE) on maximum reach distance performance between CAI and healthy participants on the SEBT and to explore the role of kinesiophobia with this functional. METHODS:Thirty-four individuals: 17 CAI (10 F/7 M; age= 21.06±3.19yr; height=171.2±11.9 cm; weight=67.7±10.8 kg) and 17 healthy controls (10 F/7 M; age=19.41 ±1.23yr; height=169.35±6.36 cm; weight=64.89±8.76kg) volunteered. Independent variables included condition (VE vs No VE) and group (CAI vs Healthy). The Fear Avoidance Beliefs Questionnaire (FABQ) was administered. Participants completed 3 SEBT trials per condition, starting with No VE followed by VE to eliminate the effect of heightened motivation with a randomized order. Analysis of Variance (ANOVA) examined group differences and whether VE affected performance for Anterior (ANT), Posteromedial (PM), and Posterolateral (PL) reach distances. FABQ was compared between the CAI and Healthy groups using a t-test; all alpha levels were <.05 a priori. RESULTS:With No VE, a significant group-by-condition interaction was observed in both the ANT (CAI: 66.90 ± 5.50 vs Healthy:70.65 ± 4.52) and PM (CAI: 77.60 ± 7.70 vs Healthy: 81.89 ± 8.25 reach directions, which diminished with VE: ANT (CAI: 70.43 ± 4.52 vs Healthy: 71.77 ± 5.10) and PM (CAI: 85.41 ± 7.19 vs Healthy: 86.45 ± 8.71), showing that the two groups behaved similarly with VE. There was no statistically significant interaction (p=0.48) for the PL reach direction without VE (CAI: 73.60 ± 7.84 vs Healthy: 75.16 ±11.72) or with VE (CAI: 80.18 ±9.79 vs Healthy: 80.06 ± 11.93). The CAI group had significantly higher FABQ scores (10.53 ±9.45) than the healthy group (0.41 ± 1.70) (p<.001). CONCLUSIONS: The CAI group had lower performance on the SEBT without VE, but with VE, the scores were comparable to healthy controls. Clinicians and researchers should acknowledge the impact that motivation and psychological stresses have on functional performance in patients with pathologies such as CAI.

Is gluteus medius injured in patients treated with a trochanter tip entry intramedullary nail? Clinical, electrophysiological and functional outcomes.

Objectives This study aims to assess the functional outcomes, static-dynamic postural stability of patients and evaluate electromyographic activity of gluteus medius (GMed) muscle during gait and spatiotemporal parameters of gait in patients after antegrade intramedullary nailing (IMN) of femoral shaft fractures with trochanter tip entry.Patients and methods Sixteen patients (15 males, 1 female; mean age 34.8±15.2 years; range, 18 to 58 years) who were treated with an antegrade trochanteric IMN between January 2009 and July 2013 and eight healthy male controls (mean age 39.3±9.8 years; range, 27 to 57 years) were included in this retrospective study. Muscle strength, static and dynamic postural stability and fall risk were evaluated. In addition, spatiotemporal parameters of gait were assessed using a validated wireless inertial sensing device and a wireless electromyography (EMG) device was used to measure electromyographic activity of GMed muscle in both groups.Results There were significant differences in muscle strength, functional and dynamic balance test scores between operated and intact sides (one-leg hop test score p=0.009, balance test scores p<0.001-0.033). There were significant differences in functional and quality of life physical function test scores between groups (one-leg hop test score p=0.014). However, no significant differences were found in EMG results, dynamics balance, and statics postural stability test scores between groups (p>0.05).ConclusionAfter isolated femur fracture, patients treated with antegrade trochanteric IMN demonstrated good static and dynamic stability and poor functional outcomes compared to controls. In conclusion, patients with antegrade trochanteric IMN have good balance but poor functional performance; however, further studies are needed to find out the primary reason for these results.

Balance Board vs Balance Ball: Which One is Superior in Enhancing Static And Dynamic Balance Abilities on Healthy University Students

Aim: The purpose of this study was to compare the effects of two different unstable surfaces balance training on static and dynamic balance abilities. Methods: The 52 healthy active university students were randomly divided into three groups: the training groups exercised on the firm (balance board) or soft ground (balance ball, BOSU®) for 16 min for 3 days per week for eight weeks, involving structured balance exercises. The control group did not perform the balance exercises in this process. All of the groups were tested static and dynamic balance tests by a computerized balance system before and after the training period. Tests were carried out using a single and double-leg stance either with the eyes open or closed. Results: One-way and mixed-design analyses of variance tests indicated that significantly similar improvements were observed in the exercise groups’ static (ellipse area and perimeter length) and dynamic (stability index and average track error) balance (p 0.05). Conclusion: Finding shows that using balance board and balance ball as balance training intervention tools have similar effectiveness for static and dynamic balance enhancement in healthy active university studen ts.

The effect of task-specific balance training program in dual-task and single-task conditions on balance performance in children with developmental coordination disorder

Background: Among the main deficits in children with developmental coordination disorder (DCD), the underdeveloped balance is important because of the impact on motor skills development, the falling risks and participation in various physical activities. Objective: The purpose of this study was to examine the effect of task-specific balance training in dual-task and single-task conditions on balance performance in children with DCD. Methods: Thirty-nine boys aged from 7 to 9 years with DCD were randomly assigned to 3 groups: dual-task training group (n = 13, mean age 8.59 &#177; 0.82 years), single-task training group (n = 13, mean age 8.61 &#177; 0.83 years) and control group without any intervention (n = 13, mean age 8.41 &#177; 0.86 years). Each session in the single-task or dual-task group continued for 45 minutes, three times per week for a duration of 8 weeks. The balance of all three groups was measured using the Stork Balance Stand Test and dynamic Y Balance Test in the pre-test, post-test (after 24 sessions), and follow-up phases (2 months after the intervention). Results: There was a significant difference between the dual-task and single-task training program in static and dynamic balance tests score during post-test. The dual-task program significantly improved the balance performance of children with DCD (p &lt; .001). Conclusions: Based on the findings of the present research, the dual-task training condition focusing on balance and cognitive tasks may improve the skills of children on performing static and dynamic balance significantly more than the single-task training.

Intrarater reliability and validity of outcome measures in myotonic dystrophy type 1.

To investigate intrarater reliability and concurrent and construct validity of muscle strength, balance, and functional mobility measures in individuals with noncongenital myotonic dystrophy type 1 (DM1). Seventy-eight adults with noncongenital DM1 participated in visit 1, and 73 of the them participated in visit 2 separated by 1 to 2 weeks. The assessments consisted of muscle strength tests with handheld dynamometry (HHD) and stationary dynamometry in the lower limb. The balance tests consisted of the step test, Timed Up and Go test, feet-together stance, tandem stance, 1-leg stance, and modified Clinical Test of Sensory Integration and Balance on a balance platform. The functional mobility tests consisted of the 10-m walk test (10mWT) and 10-times Sit-to-Stand test. The HHD and stationary dynamometry had sufficient intrarater reliability for most muscle groups on a group (SEM% ≤15%) and individual (minimal detectable difference [MDD95%] ≤30%) level, but the HHD was most reliable. Stationary dynamometry measured a higher torque than HHD for all extensor muscles, but for single individuals, none of the devices were favored. Overall, intrarater reliability and validity were sufficient only for the dynamic balance tests, not the static balance tests. Both functional mobility tests were sufficiently reliable and valid, but the 10mWT was most reliable. Overall, HHD is recommended as a reliable and valid tool for single individuals and for flexor muscles on a group level. For balance assessments, the dynamic balance tests are recommended as the most valid and reliable balance tests. Both functional mobility tests are recommended for valid and reliable outcomes, but the 10mWT was superior for reliability.

Low proportion of skeletally immature patients met return-to-sports criteria at 7 Months following ACL reconstruction

ObjectiveTo examine the proportion of skeletally immature anterior cruciate ligament reconstructed (ACLR) patients who achieve ≥90% of lower extremity recovery at 6–9 months post-operatively. DesignCross-sectional study. SettingBiomechanical laboratory. ParticipantsSkeletally immature ACLR patients. Main outcome measure(s)Muscular strength (quadriceps, hamstrings, hip abductors, and hip extensors), dynamic balance (anterior reach, posteromedial reach, and posterolateral reach), and functional hops tests (single hop, triple hops, cross-over hops, and 6 m timed hops) were examined. The primary outcome variable was the proportion of the study patients whose limb symmetry index (LSI) were ≥90% during return to sport (RTS) tests. ResultsA total of 105 skeletally immature ACLR patients who are planning to return to sporting activities (age: 13.4 ± 1.4 years) were enrolled. The proportion of skeletally immature ACLR patients who achieved ≥90% of LSI in all four strength, three balance, and four hop tests were 20.0%, 65.4%, and 27.8%. In those who completed all test battery (72/105), only 4.2% of skeletally immature ACLR patients demonstrated ≥90% of LSI in all RTS tests. ConclusionA small proportion of skeletally immature ACLR patients demonstrated ≥90% of lower extremity recovery approximately at 7 months following ACLR.

Effects of Balance Training on Postural Control of Children with Attention Deficit/Hyperactivity Disorder

Background: Children with attention-deficit/hyperactivity disorder (ADHD) have shown deficiencies in many physical activities in comparison with normally developing children. One of the problems of these children is the balance and postural control. Objectives: The aim of this study was to investigate the effects of balance training on postural control of children with ADHD. Methods: Thirty children with ADHD participated in this study and were divided randomly into experimental and control groups. The experimental group performed balance training three times per week for seven weeks. During this period, the control group did not experience any exercises but continued their normal activities. The Biodex balance system (BBS) was used to evaluate static and dynamic balance. Results: The balance training significantly increased static and dynamic balance in the experimental group (P &lt; 0.001), while the balance scores of children with ADHD in the control group did not change. Participants in the experimental group also performed static and dynamic balance tests significantly better than members of the control group (P &lt; 0.001). Conclusions: The results showed that specific balance training improves postural control of children with ADHD. These balance trainings probably lead to an adaptive mechanism in the sensory process and cerebellar integration of children with ADHD.

Inter-rater Reliability of Cervical Proprioception, Dynamic Balance and Dorsiflexion Range of Motion Ising STARmat&reg;

Purpose: This study examined the inter-rater reliability of cervical proprioception, dynamic balance ability, and ankle dorsiflexion range of motion using STARmat®, which is a practical clinical tool that can provide practitioners and patients with quantitative and qualitative results. Methods: Thirty healthy young subjects were enrolled in this study, and two well-trained physical therapists participated as a tester. Two testers measured the cervical joint position error at the starting position after neck flexion, extension, side bending, and rotation; three dynamic balance tests, including anterior excursion, anterior reaching with single leg balance, and posterior diagonal excursion; and an kle dorsiflexion range of motion using STARmat®. The intra-class correlation coefficient (ICC) was used to determine the inter-rater reli ability of the tests. Results: The inter-rater reliability for the cervical proprioception ranged from moderate to good (0.66 to 0.83), particularly for flexion (0.82), extension (0.70), right side bending (0.73), left side bending (0.71), right rotation (0.83), and left rotation (0.66). For the dynamic balance, the inter-rater reliability ranged from good to excellent (0.87 to 0.91), particularly for anterior excursion (0.86), posterior diago nal excursion (0.87 to 0.89), and anterior reaching with a single leg balance (0.90 to 0.91). In addition, for the ankle dorsiflexion range of motion, the ICC for the inter-rater reliability ranged from 0.95 to 0.96. Conclusion: STARmat® is a reliable tool for measuring cervical proprioception, dynamic balance tests, and ankle dorsiflexion range of motion in healthy young adults.

Validity of Star Excursion Balance Test as Dynamic Balance Test In Subjects with Non-Operative Anterior Cruciate Ligament Injury

Background: The anterior cruciate ligament (ACL) injury is the most common knee injury that might occur during exercise. An ACL causes a balance disorder that can be considered as a risk factor for recurring injury. Identification of balance disturbances in subjects with ACL injury should be conducted to minimize the risk of re-injury. Objectives: this study aims to determine the validity of star excursion balance test with biodex balance system SD as a gold standard Method: This study is a diagnostic test with cross-sectional study approach. The number of research sample was 20 respondents selected as control group, five people with ACL injury as the case group. All subjects were examined with the biodex balance system SD (Overall Stability Index) and star excursion balance test (% MAXD). Results: The result of the correlation analysis between the overall stability index and %MAXD was not significant with r = -0.316; p = 0.175. Hence, the cut-off point could not be determined due to the insignificant correlation, thus the sensitivity, specificity, positive predictive value, and negative predictive value of the star excursion balance test could not be determined. Conclusion: Star excursion balance test was invalid as a dynamic balance test if the Biodex Balance Test SD was used as a gold standard.

What is actually happening inside the "cone of economy": compensatory mechanisms during a dynamic balance test.

A nonrandomized, prospective, concurrent control cohort study. To further develop cone of economy (CoE) measurements by identifying compensatory mechanisms at the extremes of the CoE and comparing balance control strategies in a group of adult degenerative scoliosis (ADS) patients with non-scoliotic controls. The CoE concept was first proposed by Dubousset and is frequently referred to when assessing balance in spinal deformity patients. Recently, a method that quantifies the CoE of individual patients through 3D video kinematic and electromyography data was developed. However, this method lacks measurements that describe the motor control strategies utilized by spinal disorder patients to maintain balance. Twenty ADS patients and 15 non-scoliotic controls. All test subjects were fitted with a full body marker set. Each subject performed a series of functional balance tests (Romberg's with eyes opened) while being recorded in a human motion capture system. Three-dimensional CoE dimensions, range of sway (RoS), overall sway and lower extremity and trunk range of motion (RoM) were measured and analyzed. Patients with ADS demonstrated greater overall sway and RoS in the sagittal and coronal planes compared to controls. Moreover, ADS patients presented with more hip flexion and trunk flexion at maximal points of sway and more ankle, knee, hip and trunk RoM when swaying in comparison with controls. ADS patients have larger CoE dimensions and increased sway when compared to non-scoliotic controls. ADS patients rely on a hip balance control "strategy" and lower extremity RoM to maintain balance, which differed from control subjects. Unlike prior attempts to define compensatory mechanisms in ADS patients, the described technique utilizes dynamic, three-dimensional measurements to define what is occurring within the CoE. By expanding on prior CoE measurements, we were able to define a unique dynamic balance control strategy for each patient.

RECOVERY FOLLOWING ACL RECONSTRUCTION IN MALE VS. FEMALE ADOLESCENTS: A MATCHED, SEX-BASED COHORT ANALYSIS OF 543 PATIENTS

Background:The subject of sex-based differences in postoperative recovery after anterior cruciate ligament reconstruction (ACLR) between males and females has been incompletely investigated, with no published comparative analyses specifically in adolescent sub-populations, which represent those most affected by ACL injury.Purpose/Hypothesis:To compare the 6-month postoperative functional recovery following ACLR between adolescent males and females. We hypothesized that significant differences in postoperative strength, dynamic balance, and functional hop test performance would be seen between the sexes.Methods:All adolescent athletes with closed or closing growth plates who underwent ACLR at a single institution between May 2014 and May 2018 and who underwent functional return-to-sport (RTS) testing between 5-8 months post-operatively were considered for inclusion in this IRB-approved study. To control for potential graft-based rehabilitation differences or donor site morbidity as confounders, only primary ACLRs performed with hamstring autograft were included. Exclusions were previous knee surgery (contralateral or ipsilateral knee), concomitant injury other than meniscus tear, allograft supplementation, and incomplete medical records. Limb Symmetry Indexes (LSI) for strength (quadriceps, hamstrings, hip abductors, hip extensors), dynamic Y-balance (anterior, posterolateral and posteromedial distance), and functional hopping (single hop, triple hop, and cross-over hop for distance, and 6-meter timed hop) were compared between groups. To account for differences in physical characteristics between the sexes, one-way between group multivariate analysis of covariance (MANCOVA) was used, with p = 0.05.Results:Amongst 543 subjects (211 male, 332 female), there was no significant difference in age, BMI, incidence of concomitant meniscal pathology, use of regional anesthesia blocks, or time to functional testing between cohorts. However, height and weight differences were incorporated in the MANCOVA model. Females demonstrated a statistically significant greater deficit in quadriceps strength LSI compared to males (Table 1). Both males and females demonstrated 33% hamstring strength deficits, with no statistically significant sex-based differences in dynamic balance or functional hop testing, though single leg hop deficits were less severe in males, which trended towards significance (-4% vs. -8%, p=0.062).Conclusion:Females demonstrated greater quadriceps strength deficits than males at 6 months post-ACLR with hamstring autograft, which may translate into greater functional hop testing deficits. Severe hamstring strength deficits persist in both males and females at this time point, underscoring the potential importance of mitigating risk of ACL re-tear by delaying return to play until a later time point with more normalized, symmetric, performance-based metrics.Table 1.Strength, balance, and functional hop testing deficits in quadriceps, hamstrings, hip abductors, and hip extensorsGroupsMales(N = 211)Females(N = 332)P-valuesQuadriceps Strength: Uninvolved limb4.57±1.2 (4.40, 4.73)4.27±1.0 (4.16, 4.39)ACLR limb4.61±1.2 (4.44, 4.78)4.11±1.1 (4.00, 4.23)Deficits (LSI%)+3.4 (+0.5, +6.3)-2.3 (-5.0, +0.4)0.011Hamstrings Strength: Uninvolved limb2.31±0.7 (2.21, 2.41)2.17±0.6 (2.10, 2.24)ACLR limb1.48±0.6 (1.40, 1.57)1.40±0.6 (1.33, 1.46) Deficits (LSI%)-33.0 (-38.0,-28.0)-33.2 (-37.9, -28.6)0.943Hip abductor Strength: Uninvolved limb1.90±0.6 (1.81, 2.00)1.85±0.7 (1.76, 1.93) ACLR limb1.94±0.6 (1.86, 2.03)1.92±0.8 (1.83, 2.01)Deficits (LSI%)+3.8 (-0.8, +8.4)+6.2 (+1.9, +10.5)0.490Hip extensor Strength: Uninvolved limb3.36±1.2 (3.19, 3.53)3.25±1.0 (3.14, 3.36) ACLR limb3.41±1.3 (3.23, 3.59)3.27±1.1 (3.15, 3.38) Deficits (LSI%)+4.2 (-1.5, +9.9)+2.2 (-3.1, +7.5)0.637Anterior Reach: Uninvolved limb61.9±7.8 (60.8, 63.0)59.5±6.5 (58.8, 60.2) ACLR limb60.3±7.5 (59.3, 61.3)57.9±6.3 (57.2, 58.6) Deficits-0.7 (-3.1, +1.6)-0.9 (-3.1, +1.2)0.905Posteromedial Reach: Uninvolved limb101.6±11.2 (100.1, 103.1)94.2±8.8 (93.2, 95.2) ACLR limb101.2±11.5 (99.6, 102.7)92.9±10.6 (91.8, 94.1) Deficits+0.5 (-0.1, +0.2)+0.1 (-1.3, +1.5)0.718Posterolateral Reach: Uninvolved limb96.5±11.3 (95.0, 98.0)91.1±8.7 (90.1, 92.0) ACLR limb96.3±11.4 (94.7, 97.8)90.3±9.4 (89.3, 91.3) Deficits+0.8 (-1.1, +2.7)-0.5 (-2.3, +1.2)0.334Composite Score: Uninvolved limb95.5±8.7 (94.2, 96.9)96.6±7.3 (95.6, 97.5) ACLR limb94.8±8.8 (93.4, 96.1)95.6±8.0 (94.5, 96.6) Deficits+0.3 (-0.9, +1.4)-0.6 (-1.7, +0.5)0.319Single Hop: Uninvolved limb1.29±0.27 (1.25, 1.34)1.07±0.21 (1.04, 1.10) ACLR limb1.22±0.28 (1.18, 1.27)0.97±0.23 (0.94, 1.00) Deficits-4.0 (-6.9, -1.0)-8.1 (-10.9, -6.9)0.062Triple Hops: Uninvolved limb4.40±0.77 (4.27, 4.53)3.55±0.58 (3.47, 3.63) ACLR limb3.13±1.21 (2.92, 3.33)2.84±0.68 (2.75, 2.94) Deficits-27.0 (-32.9, -21.1)-20.0 (-25.5, -14.5)0.117Cross-over Hops: Uninvolved limb3.82±0.84 (3.68, 3.97)3.04±0.60 (2.95, 3.13) ACLR limb3.62±0.80 (3.48, 3.76)2.85±0.61 (2.75, 2.94) Deficits-4.5 (-7.0, -2.0)-5.8 (-8.1, -3.5)0.5016 meter Timed Hop: Uninvolved limb2.12±0.47 (2.04, 2.20)2.45±0.44 (2.39, 2.51) ACLR limb2.21±0.49 (2.12, 2.29)2.57±0.50 (2.50, 2.64) Deficits-1.7 (-3.9, +0.4)-3.6 (-5.7, -1.6)0.244Values are mean ± standard deviation with 95% confidence interval.* p < 0.05.Strength was measured in newton/kg.LSI = Limb Symmetry IndexDynamic balance reach was measured in centimeters.Single, triple, and crossover hop distance was measured in meters. 6 meter timed hop was measured in seconds.

6-MONTH RETURN TO SPORTS TESTING FOLLOWING ACL RECONSTRUCTION IN ADOLESCENTS WITH QUADRICEPS TENDON AUTOGRAFT VERSUS HAMSTRING AUTOGRAFT

Background: Quadriceps tendon autograft represents an increasingly popular graft option for ACL reconstruction (ACLR). However, there is a paucity of literature regarding the early post-operative effects of this graft technique on functional recovery, particularly in adolescents. Purpose/Hypothesis: To quantify post-operative strength, dynamic balance, and functional hop test performance in adolescents 6 months following ACLR with a quadriceps tendon autograft (ACLR-Q) and compare to an adolescent control group who underwent ACLR with hamstring autograft (ACLR-HS). Methods: Patients 12-19 years-old who underwent primary ACLR-Q from 2017-2019 by a single surgeon at a pediatric tertiary care hospital and performed return to sports (RTS) assessments between 5-9 months post-operatively were included. Exclusion criteria were prior ipsilateral or contralateral ACLR and concomitant procedures other than meniscal repair or meniscectomy. RTS tests included manual muscle testing of strength (hamstring, quadriceps, hip abductor), dynamic-Y-balance, and functional hop tests (single-hop, triple-hop, crossover, 6-meter timed hop). Limb Symmetry Index (LSI) was calculated for all measures and each was compared with an ACLR-HS control group using T-tests. One-way between-group multivariate analysis of covariance (MANCOVA) was utilized to control for any baseline differences. Results: There were no significant differences in age, BMI, sex, or rates of meniscal procedures between cohorts (Table 1). The small difference in time of RTS testing was controlled by MANCOVA model. ACLR-Q patients demonstrated a significantly smaller hamstring strength deficit (-3.6%) than the ACLR-HS group (-35.8%, p&lt;0.001, Table 2). The ACLR-Q group showed a significantly greater deficit in quadriceps strength (-11.9% vs. 0.9%, p&lt;0.001). Hamstring-to-quadriceps strength ratios (HS:Q) were lower in the ACLR-HS (operative limb: 0.34 +/- 0.13, non-operative limb: 0.52 +/- 0.01) than the ACLR-Q group (operative limb: 0.61 +/- 0.16, non-operative limb: 0.56 +/- 0.12). Deficits in anterior reach, composite Y-balance score, cross-over hop, timed hop, and single hop were significantly greater in the ACLR-Q group. The deficit in 6-meter timed hop was significantly greater in the ACLR-HS group. Conclusion: Quadriceps strength deficits were greater in adolescents undergoing ACLR-Q (LSI of approximately -12%), while hamstring strength deficits were greater in adolescents undergoing ACLR-HS (LSI of approximately -33%). Hamstring-to-quad ratios were greater in the ACLR-Q patients’ operative knees than their nonoperative knees, while they were significantly lower in the ACLR-HS patients’ operative knee than their nonoperative knees. Hop testing performance was mixed between the 2 graft cohorts. The degree to which these performance metrics influence eventual athletic performance and graft-retear remains a critical area of continued investigation. [Table: see text][Table: see text]